EVALUATION OF CLINICAL VERSUS IMAGING PREDICTOR MODELS OF HEAD INJURY OUTCOME

Dilip Kumar Kulkarni; Manas K. Panigrahi; Rajesh S. Reddy

Volume : VII, Issue : IV, April - 2018

EVALUATION OF CLINICAL VERSUS IMAGING PREDICTOR MODELS OF HEAD INJURY OUTCOME

Dilip Kumar Kulkarni, Manas K. Panigrahi, Rajesh S. Reddy

Abstract :

Background: Traumatic ain injury (TBI) is a global health problem and a leading cause of mortality and morbidity. The therapeutic interventions are usually based on the assessment of prognosis of TBI patients. There are not many studies comp� the predictability of clinical and investigational parameters based models. We have contemplated a study to evaluate the clinical and imaging regression models and assessing and comp� the clinical versus imaging models.

Methods: 100 patients were enrolled. 10 clinical variables and 3 imaging variable were recorded. Initially all the variables were analyzed and ranking was done. The clinical variables selected were age, GCS, pupillary reaction to light, reparatory rate, anisocoria and SBP(systolic Blood Pressure) and imaging variables selected were the petechial hemorrhages, obliteration of third ventricle or basal cisterns and midline shift depending upon �p� value of <0.05. Two models clinical and imaging were developed using binary logistic regression analysis. Both the models were assessed by sensitivity, specificity, accuracy, Hosmer – Lemeshow test and AUC (area under the curve) of ROC (receiver operating characteristic curve) curve. The internal validation of the two models was done by estimation of error rate, crossvalidation and bootstrapping. The models were compared by �Z� test.

Results: The sensitivity, specificity, accuracy and AUC of ROC of the clinical model are 98%, 76%, 94% and 0.94 respectively. The sensitivity, specificity, accuracy and AUC of ROC of the imaging model are 85%, 100%, 99% and 0.91 respectively. The sensitivity, accuracy and AUC of ROC are higher in clinical model whereas the specificity is more with imaging model. The internal validation and �Z� test revealed no significant difference between clinical and imaging models.

Conclusions: The clinical model gives an equally good estimation of prognosis and useful particularly at site of injury or any natural disaster for triage.